Products & Services

Resources

An ASHA calls me and tells me stories of change

December 8, 2011

Share

Image from USAID

The 50 countries where CommCare is being used

CRS supports health systems strengthening work in the state of Uttar Pradesh with a mobile health initiative that works with community level maternal and child health workers. These community workers, known as ASHAs, are members of the village where they work and receive small government stipends for doing outreach to pregnant and lactating women. With private funding, CRS created a mobile health tool that puts ICT4D solutions on basic phones. The app prompts ASHAs on what messages to communicate during each visit. The messages are all given from an audio recording and color coded, allowing illiterate ASHAs to follow the standard government curriculum. They record information about each woman’s pregnancy and delivery in the app. Prior to using a mobile device, ASHAs often forgot which messages to deliver at what time, or they gave all pregnancy messages in one sitting, regardless of where a woman was at in her pregnancy.
Here, ASHA Sunita Prajapati, 26, counsels Nirmala Devi, 26 (green sari). This is Nirmala’s second pregnancy.
Sunita is a single mother of a 6-year-old girl, as her husband left when she was pregnant. She lives in her mother’s home. She had completed 12 years of education when she became an ASHA, but with her earnings as a community health worker, she was able to pay her own tuition for a bachelor’s degree (equivalent of an associate’s degree in the U.S.). She saves every rupee she can for her daughter’s education, and she is also responsible for all of the household expenses. She has helped more than 500 pregnant and lactating women since she started working as an ASHA in 2007.

Jonathan Jackson, Founder and Chief Executive Officer, Dimagi, USA; Social Entrepreneur at the World Economic Forum – Annual Meeting of the New Champions in Dalian, People’s Republic of China 2015. Copyright by World Economic Forum / Sikarin Fon Thanachaiary

Three months ago, I felt especially connected of a story Rekha told me of one woman in her village.This woman’s husband is an alcoholic and forbids her from going to the Anganwadi center, or speaking to the ASHA. This woman heard about ‘the program Rekha was given in her mobile phone for pregnant woman’ through word of mouth. This could happen when women go to fetch water, or walking to the fields. This woman snuck away from the home without her husband knowing to the Anganwadi center on several occasions to learn the information and benefit from the program. She had heard there’s information about pregnant woman that Rekha has to share, and she also felt like she should hear it!

my first takeaway: A novel tool can attract people and want to access information through it.

I asked about this woman today. Rekha said, she came to learn the information from CommCare (which was a big step on its own), but never took up the practices as they was forbidden by her husband. This woman was the only woman in her village, who experienced complications during pregnancy, was transferred to Ajmer for emergency care and lost lots of blood there. Her newborn died within 4 days. She’s recovered now.

Rekha said, the main problem was the husband hadn’t arranged for transport in advance, didn’t allow her to take the pills, let her get looked at by an ANM (auxilliary nurse midwife) or get immunized. I wonder what he’ll decide to allow/disallow for their next pregnancy after being the only family that did not follow the practices encouraged in the application.

my second takeaway: People learn from real stories and do what other people do right. I wonder if Rekha will cite this example as a behaviour change weapon along with CommCare.

Rekha was among the top performers for form completions and case activity rates. Every single pregnant woman who saw CommCare in the past 6 months had a healthy pregnancy and are now breastfeeding, except one. (She’s only had an about 7-8 pregnant woman in the past 6 months). By way of example of that one woman’s story, I wonder how people’s opinions have formed for the information in CommCare and the credibility of the ASHA. Through CommCare, ASHAs are able to share information, comprehensively, correctly and with credibility. Now, let’s hope it can motivate service uptake and break down barriers.

On that note, I think there’s so much value in filling out the counselling type forms within the home, where there is a higher probability of a (resistant) family member being present and at the very least half-listening.

my third takeaway: Encourage ASHAs to complete all counselling forms at the home, instead of at the Anganwadi Center, where household decision makers may also tune in and learn.